The Predictors of Surgery for Symptomatic, Atraumatic Full-Thickness Rotator Cuff Tears Change Over Time: Ten-Year Outcomes of the MOON Shoulder Prospective Cohort.

IF 4.4 1区 医学 Q1 ORTHOPEDICS Journal of Bone and Joint Surgery, American Volume Pub Date : 2024-09-04 Epub Date: 2024-07-09 DOI:10.2106/JBJS.23.00978
John E Kuhn, Warren R Dunn, Rosemary Sanders, Keith M Baumgarten, Julie Y Bishop, Robert H Brophy, James L Carey, Brian G Holloway, Grant L Jones, C Benjamin Ma, Robert G Marx, Eric C McCarty, Sourav K Poddar, Matthew V Smith, Edwin E Spencer, Armando F Vidal, Brian R Wolf, Rick W Wright
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Abstract

Background: A prospective cohort study was conducted to assess the predictors of failure of nonoperative treatment, defined as the patient undergoing surgery for symptomatic, atraumatic full-thickness rotator cuff tears. We present the 10-year follow-up data of this population to determine if predictors for surgery change over time, and secondarily we report the outcomes of the cohort.

Methods: At the time of enrollment, demographic, symptom, rotator cuff anatomy, and patient-reported outcome data were collected in patients with symptomatic, atraumatic full-thickness rotator cuff tears. Patients underwent a standard physical therapy protocol for 6 to 12 weeks. Patient data were then collected at 1, 2, 5, 7, and 10 years. Failure of nonoperative treatment was defined as the patient electing to undergo surgery.

Results: Of the 452 patients in the original cohort, 20 patients (5%) withdrew from the study, 37 (9%) died before 10 years, and 40 (9%) were otherwise lost to follow-up. A total of 115 patients (27.0%) underwent a surgical procedure at some point during the 10-year follow-up period. Of these patients, 56.5% underwent surgery within 6 months of enrollment and 43.5%, between 6 months and 10 years. Low patient expectations regarding the efficacy of physical therapy were found to be a predictor of early surgery. Workers' Compensation status and activity level were more important predictors of later surgery. Patient-reported outcome measures all improved following physical therapy. For patients who did not undergo a surgical procedure, patient-reported outcome measures did not decline over the 10-year follow-up period.

Conclusions: Low patient expectations regarding the efficacy of physical therapy were found to be a predictor of early surgery, whereas Workers' Compensation status and activity level were predictors of later surgery. Physical therapy was successful in >70% of patients with symptomatic, atraumatic full-thickness rotator cuff tears at 10 years. Outcome measures improved with physical therapy and did not decline over the 10-year follow-up period.

Level of evidence: Prognostic Level I . See Instructions for Authors for a complete description of levels of evidence.

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症状性、创伤性全厚肩袖撕裂手术的预测因素随时间变化:MOON 肩部前瞻性队列的十年结果。
研究背景我们开展了一项前瞻性队列研究,以评估非手术治疗失败的预测因素。非手术治疗失败是指无症状、创伤性全厚肩袖撕裂患者接受手术治疗。我们提供了该人群 10 年的随访数据,以确定手术的预测因素是否会随着时间的推移而发生变化,其次我们还报告了该人群的治疗结果:在入组时,我们收集了无症状、创伤性全厚肩袖撕裂患者的人口统计学、症状、肩袖解剖和患者报告的结果数据。患者接受为期 6 至 12 周的标准物理治疗方案。然后分别在1年、2年、5年、7年和10年收集患者数据。非手术治疗失败的定义是患者选择接受手术治疗:在最初的 452 名患者中,有 20 名患者(5%)退出了研究,37 名患者(9%)在 10 年前去世,40 名患者(9%)失去了随访机会。共有 115 名患者(27.0%)在 10 年随访期间的某个时间点接受了手术治疗。其中,56.5%的患者在入组 6 个月内接受了手术,43.5%的患者在 6 个月至 10 年间接受了手术。研究发现,患者对物理治疗疗效的期望值过低是导致早期手术的一个预测因素。工伤赔偿状况和活动水平则是后期手术的重要预测因素。物理治疗后,患者报告的结果均有所改善。对于没有接受手术治疗的患者,在10年的随访期间,患者报告的疗效指标并没有下降:结论:研究发现,患者对物理治疗疗效的期望值过低是导致早期手术的一个预测因素,而工伤赔偿状况和活动水平则是导致后期手术的预测因素。超过70%的无症状、创伤性全厚肩袖撕裂患者在接受物理治疗10年后取得了成功。物理治疗后的结果指标有所改善,并且在10年的随访期间没有下降:有关证据等级的完整描述,请参阅 "作者须知"。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
CiteScore
8.90
自引率
7.50%
发文量
660
审稿时长
1 months
期刊介绍: The Journal of Bone & Joint Surgery (JBJS) has been the most valued source of information for orthopaedic surgeons and researchers for over 125 years and is the gold standard in peer-reviewed scientific information in the field. A core journal and essential reading for general as well as specialist orthopaedic surgeons worldwide, The Journal publishes evidence-based research to enhance the quality of care for orthopaedic patients. Standards of excellence and high quality are maintained in everything we do, from the science of the content published to the customer service we provide. JBJS is an independent, non-profit journal.
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